An active ingredient in heroin may be effective in weaning opioid addicts and keeping them in treatment.

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MONDAY, March 12, 2012 (MedPage Today) — Diacetylmorphine, the active ingredient in heroin, may be more effective and less costly than methadone for refractory opioid addiction, researchers found.

In a mathematical model, patients on diacetylmorphine gained slightly more quality-adjusted life-years (known as QALYs) at a lower cost than those on methadone maintenance therapy, Aslam Anis, MD, of the University of British Columbia, and colleagues reported online in CMAJ.

"Over a lifetime horizon, the provision of diacetylmorphine in the hypothetical cohort provided greater incremental health benefits and reduced the total costs to society compared with methadone maintenance treatment," they wrote.

The benefit arose largely from the fact that patients on diacetylmorphine remained in treatment longer, which substantially reduced the costs associated with crime, because patients were less likely to break the law while in therapy, the researchers explained.

Methadone is the most common form of opioid substitution therapy, but it doesn't work for 15 percent to 25 percent of patients, the researchers said.

Diacetylmorphine, on the other hand, has been proven to be more effective than methadone maintenance for opioid addiction, but its direct costs are higher, they said.

So to assess its cost-effectiveness in refractory patients over the long haul, Anis and colleagues created mathematical models using data from the North American Opiate Medication Initiative trial.

This Canadian trial found diacetylmorphine to be more effective than methadone at keeping patients in treatment, and at improving health and social functioning in patients with chronic opioid dependence refractory to treatment.

The current researchers supplemented this data with administrative data from British Columbia and other published data to develop a semi-Markov cohort model. Costs were calculated in Canadian dollars.

Overall, they found that diacetylmorphine was a dominant strategy over methadone for every time horizon, including the lifetime horizon.

While patients on methadone gained an average 7.46 QALYs and generated a societal cost of $1.14 million, those on diacetylmorphine gained an average 7.92 QALYs and generated a cost of $1.10 million.

Anis and colleagues said the cost savings in the diacetylmorphine cohort were attributable to reductions in costs related to criminal activity.

"Because opioid users commit less crime and have lower rates of healthcare use and death while in treatment, the benefits in cost and health utility attributable to diacetylmorphine stemmed chiefly from its capacity to retain patients in treatment for longer periods than with methadone maintenance therapy," they wrote.

Diacetylmorphine remained cost-saving in almost all sensitivity analyses, with the exception of a Ministry of Health perspective that didn't include crime-related or out-of-pocket costs. It did, however, remain cost-effective in this analysis at an incremental cost-effectiveness ratio (ICER) of $85,600 per QALY gained, they reported.

The study was limited by a lack of complete data on opioid users who actually achieved abstinence and because gains in productivity weren't incorporated, although the original trial found these costs didn't differ between groups.

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